Azar Denise, Wang Sofia, Flemming-Judge Liz, Shee Anna Wong, Jessup Rebecca, Sharma Laveena, Fukumori Shihoko, Talevski Jason, Nicholls Stephen J, Harris James, Alston Laura, Martin Catherine, Oqueli Ernesto, van Gaal William, Beauchamp Alison
School of Rural Health, Monash University, Warragul, Australia.
Victorian Heart Institute, Monash University, Melbourne, Australia.
Health Expect. 2025 Jun;28(3):e70328. doi: 10.1111/hex.70328.
The burden of coronary heart disease (CHD) is disproportionately greater among socio-economically disadvantaged groups. Health services play a crucial role in addressing this social gradient by ensuring equitable access to care. However, there is limited evidence on effective strategies to improve health service accessibility for CHD patients, particularly those that are codesigned with people with lived experience and clinicians. The Equal Hearts study aimed to codesign a health literacy-based intervention to improve the accessibility of hospital-based cardiac services for underserved population groups with CHD.
This study employed a mixed-methods approach based on codesign principles. The study comprises three phases: identifying and understanding the problem, codeveloping an intervention, and translating the intervention into practice. Phases 1 and 2 are reported in this paper and included focus groups, interviews and an intervention development workshop. Participants for focus groups and interviews were recruited from four health services in [Victoria] and included patients with CHD, health consumers from culturally diverse communities and clinicians. Findings from focus groups and interviews were analysed via thematic analysis using Levesque's conceptual framework to identify health literacy barriers to accessibility of cardiac services. These barriers were prioritised in a codesign workshop with cardiac patients, health consumers and clinicians.
Thirty-seven cardiac patients, 10 clinicians and 44 culturally diverse health consumers participated in focus groups/interviews. Among these participants, eight cardiac patients/carers and five clinicians attended the workshop. Cardiac patients reported a lack of preparedness for hospital discharge and feeling 'lost' and uncertain about how to confidently manage their health at home after a cardiac event. A codesigned intervention-The Patient Discharge Action Plan-aims to improve patients' transition from hospital to home.
Using a codesign approach and health literacy principles, a health service intervention was developed to improve accessibility of cardiac services. The Patient Discharge Action Plan is currently being evaluated in a pilot RCT.
Two consumer co-authors [L.F.J. and J.H.] informed the development of the study protocol. A Stakeholder Advisory Panel, including six people with lived experience of CHD and four clinicians/health service managers from participating sites, guided all steps within this study.
ACTRN12624000780550p (Australian and New Zealand Clinical Trials Registry). Registered on 25 June 2024.
冠心病（CHD）在社会经济弱势群体中的负担尤为沉重。卫生服务在通过确保公平获得医疗服务来消除这种社会差异方面发挥着关键作用。然而，关于改善冠心病患者获得卫生服务的有效策略的证据有限，特别是那些与有实际经验的人和临床医生共同设计的策略。“平等之心”研究旨在共同设计一种基于健康素养的干预措施，以改善为患有冠心病的服务不足人群提供的医院心脏服务的可及性。
本研究采用基于共同设计原则的混合方法。该研究包括三个阶段：识别和理解问题、共同开发干预措施以及将干预措施转化为实践。本文报告了第1阶段和第2阶段，包括焦点小组、访谈和一次干预措施开发研讨会。焦点小组和访谈的参与者从[维多利亚州]的四个卫生服务机构招募，包括冠心病患者、来自文化多元社区的卫生消费者和临床医生。使用莱韦斯克的概念框架，通过主题分析对焦点小组和访谈的结果进行分析，以确定心脏服务可及性方面的健康素养障碍。在与心脏病患者、卫生消费者和临床医生共同设计的研讨会上，对这些障碍进行了优先排序。
37名心脏病患者、10名临床医生和44名文化多元的卫生消费者参加了焦点小组/访谈。在这些参与者中，8名心脏病患者/护理人员和5名临床医生参加了研讨会。心脏病患者报告说，出院时没有做好准备，在心脏病发作后在家中对如何自信地管理自己的健康感到“迷茫”和不确定。一项共同设计的干预措施——《患者出院行动计划》旨在改善患者从医院到家庭的过渡。
采用共同设计方法和健康素养原则，开发了一种卫生服务干预措施，以提高心脏服务的可及性。《患者出院行动计划》目前正在一项随机对照试验试点中进行评估。
两位消费者共同作者[L.F.J.和J.H.]为研究方案的制定提供了信息。一个利益相关者咨询小组，包括6名有冠心病实际经验的人和4名来自参与地点的临床医生/卫生服务经理，指导了本研究的所有步骤。
ACTRN12624000780550p（澳大利亚和新西兰临床试验注册中心）。于2024年6月25日注册。
